Gralise (gabapentin extended-release) — CareFirst (Caremark)

Preferred products

• gabapentin immediate-release

Initial criteria

• The request is for Lyrica (pregabalin immediate-release)
• The requested drug is being prescribed for ONE of the above indications
• If the request is for Lyrica oral solution, the patient has difficulty swallowing oral solid dosage forms OR requires a dose not obtainable using capsules

Reauthorization criteria

• The request is for Lyrica (pregabalin immediate-release)
• The requested drug is being prescribed for one of the same indications
• If the request is for Lyrica oral solution, patient has difficulty swallowing oral solid dosage forms OR requires a dose not obtainable using capsules
• The patient has achieved or maintained a positive clinical response to the requested drug

Approval duration

12 months